Endocrine

Question 1

Normal 8hr fasting adult blood sugar values (venous sample)

Answer 1

70-100 mg/dL

Question 2

Prediabetes blood sugar fasting (impaired fasting glucose)

Answer 2

100-125 mg/dL

Question 3

Prediabetes blood sugar 2 hours PPG value (impaired glucose tolerance)

Answer 3

140-199 mg/dL

Question 4

4 means of diagnosing diabetes

Answer 4

2 occations of: _>_6.5% HbA1C, _>_126 fasting, SINGLE GTT _>_200, OR symptoms present with _>_200 ramdom

Question 5

Normal hemoglobin A1c range

Answer 5

2.2-4.8%

Question 6

Hemoglobin A1c is an index of average _____ over the prior _____ (time span)

Answer 6

Hemoglobin A1c is an index of average *blood glucose levels* over the prior *2-3 months*

Question 7

Blood glucose “panic” values?

Answer 7

_>_400 mg/dL or < 40mg/dl

Question 8

C-peptide chain test used to identify what?

Answer 8

Severe insulin deficiency

Question 9

When would you use an antibody test for DM? (glutamic acid decarboxylase, tyrosine phosphate, insulin Ab’s, Islet Cell Ab’s)

Answer 9

Only if you are unsure of type 1 vs. type 2

Question 10

Which of the following thyroid conditions cause abnormal function? Which typically do not?

Answer 10

Hypothyroidism Hyperthyroidism Thyroiditis Thyroid nodules Thyroid cancers

Question 11

What is the initial screening test for thyroid function?

Answer 11

TSH/thyrotropin

Question 12

What is a normal TSH value range? is fasting required?

Answer 12

0.5-5.0 mlU/L. no.

Question 13

What drugs may increase TSH? (2)

Answer 13

*Lithium,* Potassium iodide

Question 14

What drugs may decrease TSH? (4)

Answer 14

ASA NSAIDS Heparin Corticosteroids

Question 15

What circulating proteins affect TOTAL TH levels (but not free T3, T4)?

Answer 15

TBG, albumin

Question 16

Will alterations in the amount of TBG (thyroid binding globulin) be symptomatic?

Answer 16

NO

Question 17

In what conditions/states will there be an INCREASE in TBG? (3)

Answer 17

*High estrogen states (pregnancy, OCPs) Infectious hepatitis*

Question 18

In what conditions/states will there be a DECREASE in TBG? (6)

Answer 18

*Liver disease, Major stress,*Malnutrition,Protein losing nephropathy, Androgens, Estrogen deficiency (menopause), stress

Question 19

To which two proteins do thyroid hormones bind?

Answer 19

TBG, Albumin

Question 20

Used as a tumor marker for thyroid malignancy

Answer 20

Thyroglobulin

Question 21

Tested after thyroidectomy (and radioactive iodine ablations) to see if functional thyroid tissue

Answer 21

Thyroglobulin

Question 22

What is the most common cause of hypothyroidism?

Answer 22

Hashimoto’s (autoimmune)

Question 23

In hypothyroidism, labs will show __ T4, __ TSH, and positive __

Answer 23

In hypothyroidism, labs will show *decreased* T4, *increased* TSH, and positive *thyroid antibodies*

Question 24

What is the most common cause of hyperthyroidism?

Answer 24

Graves’ (autoimmune)

Question 25

In hyperthyroidism, labs will show __ T4, __ TSH, and positive \_\_

Answer 25

In hyperthyroidism, labs will show \*increased\* T4, \*decreased\* TSH, and positive \*Thyroid Stimulating Immunoglobulins\*

Question 26

What are the cells that produce epinephrine and norepinephrine? Where are these cells located?

Answer 26

Chromaffin cells, Adrenal medulla

Question 27

What is a rare tumor of chromaffin cells?

Answer 27

Pheochromocytoma

Question 28

Signs/symptoms of a pheochromocytoma mock what other condition?

Answer 28

Anxiety/panic attack

Question 29

In what conditions is aldosterone elevated? (4)

Answer 29

Hyperaldosteronism (Conn's), Congenital adrenal hyperplasia, Hypoatremia, Hyperkalemia

Question 30

In what conditions is aldosterone decreased? (4)

Answer 30

Addison's, Renin deficiency, Hyperatremia, Antihypertensive therapy

Question 31

Cortisol opposes what other secretion?

Answer 31

Insulin (increases insulin resistance)

Question 32

Cortisol __ blood sugars

Answer 32

Raises

Question 33

What conditions/diseases cause an increase in cortisol? (4)

Answer 33

\*High estrogen states (pregnancy, OCPs),\*Cushing's\*, \* Stress, Alcoholism, Depression, Anorexia, Obesity

Question 34

What conditions/diseases cause a decrease in cortisol? (3)

Answer 34

Adrenal insufficiency (Addison's), Congential adrenal hyperplasia, Hypothyroidism

Question 35

What are some screenings for Cushing's disease/syndrome? (3)

Answer 35

Overnight dexamethasone suppression test, 24 hr urine, 11pm salivary cortisol

Question 36

What conditions are required for an insulin level

Answer 36

fast for 8 hrs, pack in ice

Question 37

Is whole blood or plasma preferred for glucose levels

Answer 37

Plasma (will read 12% higher than whole blood)

Question 38

What amount of glucose is given for GTT? What conditions does the test require?

Answer 38

75g administered. Must have been fasting for 8-10 hours and able to take glucose levels 2 hours after administration. 1 hr for gestational diabetes.

Question 39

In what tubes are glucose levels and A1C levels taken?

Answer 39

Glucose= red or tiger top. HbA1C= lavender

Question 40

An elevated C-peptide or insulin level could indicate (2)

Answer 40

insulinoma or type 2 diabetes

Question 41

What test measures acetone and acetoacetate in the urine

Answer 41

nitroprusside reaction

Question 42

How will factitious insulin affect screening tests for diabetes

Answer 42

the insulin levels will be abnormally high, but c-peptide is not (normally c-pep is eqimolar)

Question 43

Interfering factor for TSH levels (2)

Answer 43

nutritional status, radioactive I

Question 44

How is the overnight dexamethazone suppression test performed

Answer 44

administer dexamethasone (glucocorticoid suppressant) at 11:30 to measure whether morning corticol levels are lowered

Question 45

3 means of testing cortisol levels

Answer 45

blood, urine, or salivary

Question 46

How is adrenal insufficiency tested via ACTH stimulation? What disease is this useful for?

Answer 46

COSYNTROPIN TEST: check if cortisol, aldosterone rise appropriately at 30, 60 mins. Addison's.

Question 47

What is the action of aldosterone

Answer 47

sodium/water absorption and potassium excretion

Question 48

What test is used when hyperaldosteronism is suspected. In what position must the patient be placed for the blood draw?

Answer 48

aldosterone levels. Upright (aldosterone levels lower when lying down)

Question 49

what is the screening test of choice for pheo's

Answer 49

metanephrine(including normetanephrine)